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TATE OF COLORADO <br />DIVISION Of MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303; 866-3567 <br />FAX: {303) 832-8106 <br />RECEIVED <br />JAN 2 9 2003 <br />Division of Minerals and GeoloAY <br />CONSTRUCTION MATEBSALS <br />REGULAR (112) OPERATION <br />RECLAMATION PER'VIIT APPLICATI03~ FORM <br />CHECK O?~.~: ~ There is a Ft7r Number Already Assign ~ d to this Operation <br />Permit # M - 98 - O/4 -, (Please reference the Sle number currmmtly assigned to this operation) <br />_ New Application (Rule 1.4.5) / Amendment Application (Rule 1.10) <br />Conversion Applicator (Rule 1.11) <br />Permit # IvI -~~- D /4 -_ (provide for Amendments and Conversions of existing permits) <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SAFETY <br />Bill Owens <br />Governor <br />Greg E. Nraicher <br />Executive Director <br />Ronald W. Cattany <br />Atting Division Director <br />The application for a Conshvction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, a~ sections of Exhibit 6.5 (Geotec}mical Stability Exhibit; and (3) ffie application fee. When you submit your <br />application, be sure to include one (1) comole[e stared and notarized IVORY ORIGINAL and one (I) copy ofthe completed ITS application <br />form, two (2) copies of Exhibits A-S, Addendum I, appropriate sections of 6.5 (Creoteclmical Stability Exlnbit, and a check for the application <br />fee descnbed ender Section (4) below. Exhibits shonid NOT be bound or in a 3-ring binder; maps should be folded to 81/2" X I l" or 8 ]/2" <br />X I4" size. To expedite processing, please provide the information in the formal mmd order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, ALL information requested below. <br />1. AnilrcanUooerator or company name tname !o be used on iermht): L Ariv,P6E !T/EST~l'NG. <br />1.1 Type ofarganization (corporation, parnrerslrip, etc.): l~rpora~fian <br />1.2 I.RS. Tax I.B. No. or Social Security Nmmber: z5" /S3/2 95 <br />2. Operation name foil. mine or site name): <br />3. Permitted aerea¢e (new or esiatm¢ site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Petmit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.d Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditieta) to be mined: ,viand 6ra/el <br />5.1 Incidental commoditie(s) to be mined: 1. lbs/7'ons/vt <br />/20. 94 permitted acres <br />3¢ 63 acres <br />/55.57 acres <br />$2 344.00 application fee <br />2 6.00 quarry application <br />$1938 amendment fee <br />$2.344.00 conversion fee <br />2. / Ibs/1'ons/vr <br />3. ! Ibs/Tons/vr 4. / Ibs/Tonshr 5. / Ibsffons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ~ons'~/ve f%on /U/G+~er/[t/S <br />5.3 Anticipated end nse of incidental commoditie(s) to be mined: /V f1 <br />.P/+NCH ,ap~vvB prr <br />